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Flashcards in Colorectal cancer Deck (25):
1

List the two types of polyps with malignant potential

adenomatous
serrated

2

Serrated polyps are more associated with mutations in ________

DNA mismatch repaire and BRAF

3

What is the first gene mutation in the sequence from normal--> adenoma--> carcinoma

APC- initiating event for 80% of sporadic colorectal carcinoma

4

APC protein normally binds _____ and targets it for destruction

B catenin

5

When APC is mutated, B catenin accumulates, translocates to the nucleus, and causes ________

increased proliferation

6

What is the key mutation in FAP?

APC

7

List genes that are mutated later in the adenoma to carcinoma sequence?

KRAS, DCC, TP53

8

What is the key mutation in HNPCC

inactivation of DNA mismatch repair genes (MLH1, MSH2) leading to microsatellite instability

9

List risk factors for colorectal cancer

family history
IBD
diet
sedentary lifestyle
race
cigarettes/ alcohol

10

List tests that detect cancer but not polyps

Guaiac based Fecal occult blood test (gFOBT) - yearly
Immunochemical based Fecal occult blood test (iFOBT) - yearly
Cologuard - every 3 years

11

List tests that detect polyps and cancer

Flexible Sigmoidoscopy every 5 years
Colonoscopy every 10 years
Barium enema every 5 years
CT colonography every 5 years

12

Compare the presentation of right vs left colon cancers

Right: occult bleeding, anemia
Left: colonic obstruction, change in bowel habits

13

List presenting complaints of rectal cancer

bleeding
changes in stool caliber
back or sacral pain
tenesmus

14

_____ is not diagnostic for colon cancer but is important for following lesions over time

CEA

15

______ is critical for pre-operative assessment of metastatic disease

CT of chest, abdomen, pelvis

16

______ is a mandatory part of staging of rectal cancer because it allows for assessment of tumor depth, and helps guide treatment approach

trans-rectal ultrasound

17

Colon cancer most often metastasizes to _____

liver

18

Rectal cancer most often metastasizes to

lungs or liver

19

What is the surgical approach for localized colon cancer ?

resection (usually hemicolectomy) with removal of tumors lymphovascular drainage basin

20

Most patients with stage III colon cancer are offered adjuvant chemotherapy with _____

FOLFOX, 5-FU, leucovorin, oxaliplatin

21

There is a benefit to ___________ treatment for stage II or III rectal cancers

neoadjuvant chemoradiation

22

List two surgical approaches to rectal cancer

LAR: low anterior resection, used for tumors in the upper 1/3 of the rectum. sphincter sparing

APR: abdomino-perineal resection, used for lower tumors. not sphincter sparing- permanent colostomy

23

True or false: some metastatic colon cancers are curable

true- if single metastasis to liver that can be adequately resected

24

Cetuximab and panitumumab are _____________ antibodies

epidermal growth factor receptor

25

Bevacizumab is a ___________ antibody

VEG-F